Inhaled, topical & nebulizer Flashcards
which is more common in the hospital
nebulizer
NEBULIZER vs. INHALER
Nebulizer = process of adding medications or moisture to air, drug is converted into a mist, much finer than inhaler inhaler = hand held, aerosol spray, mist or powder, requires coordination
Why use inhaled
- Quicker absorption
- chronic respiratory diesase
- resucue vs. maintaince
- IF MORE THAN ONE INHALER. USE BRONCHODILATOR FIRST
- promot patient autnomoy & control of airways
Inhaled meds
may end up having systemic effects
MDI metered dose inhalers
- MDI deleivers a measured dose
- can be squeeze or breath active
- Needs to be shaken vigeourly
- patiens need enough strength to depress canister
- EDUCATION = essential
How does spacer improve delivery
Traps medication released from MDI, patient then inhales the drug from device, improve correct dose
- Inhale deeply & slowly for 3-5second, hold breath for 10 seconds & remove spacer
- face mask for younger than 4
DPI - Dry powder inhalers
dry powdered meds that create an aerosol when patient inhales through reservoir
- requires less manual dexterity then MDI
- no coordination
- med can clump if they exhale into mouth piece
Common problems of using an inhaler
- not as presecribed
- incrorrect activation: pressing canaister before breath
- forgeting to shake
- not waiting long enough between puffs
- faulture to clean the valve
- failure to observe if its actually releasing anything
- failure to recognize when empty
Determining use of inhaled decides
1) Cognitive ability
2) strong eye & hand & mouth coordination
3) hand strength & mobility
4) deep breath for 10s?
IF NOT MIGHT NEED NEBULIZER
Nursing implications of inhalers
- allow 20-30s to elapse between doses
- allow 2-5 mins between different inhalers (starting with bronchodilator)
- thorough mouth care especially after steroid based to avoid thrush or mouth ulcers (swish & spit)
Neubulizers
delivery of moisture or medication through fine mist
- nose or mouth
- adding moisture improves clearance of pulmonary secretions
- For Bronchodilation, mucolytic, corticosteroids
Implementation of nebulizer
- turn on small value neb or air (NOT O2)
- encourage end-inspiratory pause for 2-3 seconds then exhale
- if dyspneic encourage to hold eery 4-5 breaths for 10 seconds
- usually over 10-15 mins
- tap cup
- rinse mouth if steroids are given
- cough to get ride of mucous
PRN inhaled meds
-dysnieic, distress, unproductive respirations .. need assessment
What are unexpected outcome
- shallow rapid breathing & wheezing
- paroxysms of coughing
- cardiac dyrhymias (syncope)
- unable to self admin
- not understanding
- breathing inactive or coughing evaluate & notify
- with signs of dysrhythmia/cardiac issue - hold med, evaluate & notify
- teach back
Special paediatric consideration
- use a mask if too young to hold
- instruct to breath normal w/ mouth open
- educate
